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Foodborne Transmission of Hepatitis E Virus from Raw Pork Liver

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Foodborne Transmission of Hepatitis E Virus from Raw Pork Liver LETTERS et al. The nosocomial transmission of through ingestion of raw pig liver sau- the sample was tested 10 weeks after Helicobacter cinaedi infections in im- sages (figatellu [plural: figatelli]) in the family lunch, the daughter’s HEV munocompromised patients. Intern Med. 2010;49:1733–9. http://dx.doi.org/10.2169/ southeastern France. viral load was too low to enable se- internalmedicine.49.3649 The index case-patient was a quence characterization and clustering 8. Tomida J, Oumi A, Okamoto T, Morita Y, 45-year-old woman from Hyères of HEV strains. Three other family Okayama A, Misawa N, et al. Compara- (southeastern France) who had no members were IgG positive for HEV, tive evaluation of agar dilution and broth microdilution methods for antibiotic sus- underlying medical condition. She indicating previous HEV infection. ceptibility testing of Helicobacter cinaedi. visited her general practitioner on Leftover sausages had been kept frozen Microbiol Immunol. 2013;57:353–8. http:// December 17, 2013, reporting 3 days and were available for HEV testing. dx.doi.org/10.1111/1348-0421.12044 of weakness. Acute hepatitis was HEV RNA was detectable from 9. Oyama K, Khan S, Okamoto T, Fujii S, Ono K, Matsunaga T, et al. Identification diagnosed 2 days later on the basis the leftover sausages, and HEV se- of and screening for human Helicobacter of elevated liver enzymes (alanine quences were amplified in 2 different cinaedi infections and carriers via nested aminotransferase 1,265 IU/L [refer- genomic regions (ORF1: RNA-depen- PCR. J Clin Microbiol. 2012;50:3893–900. ence <35 IU/L]) and bilirubin (65 dent RNA polymerase and ORF2), as http://dx.doi.org/10.1128/JCM.01622-12 10. Taniguchi T, Sekiya A, Higa M, Saeki Y, μmol/L [reference <17 μmol/L]). Se- described previously (2). Comparison Umeki K, Okayama A, et al. Rapid iden- rum markers for acute hepatitis A, B, with the index case-patient’s sequenc- tification and subtyping of Helicobacter and C; cytomegalovirus; and Epstein- es showed 100% nt identity for both cinaedi strains by intact-cell mass spec- Barr virus were negative. Jaundice regions (Figure). Samples of food and trometry profiling with the use of ma- trix-assisted laser desorption ionization- appeared on December 19, and the samples from the index case-patient time of flight mass spectrometry. J Clin patient was referred to the Medical were analyzed in 2 independent labo- Microbiol. 2014;52:95–102. http://dx.doi. Unit of Hyères for additional investi- ratories to avoid any cross-contamina- org/10.1128/JCM.01798-13 gations. A serum sample collected on tion. The level of contamination of the December 20 tested positive for HEV figatellu was ≈4.8 104 copies of HEV Address for correspondence: Risako Kakuta, RNA; viral load was 3.3 log IU/ RNA/g of sausage (3). Department of Infection Control and Laboratory 10 mL (Ceeram, La Chapelle sur Erdre, Figatellu, a dried sausage, contains Diagnostics, Tohoku University Graduate France), and IgM and IgG against 30% pork liver and no heating step oc- School of Medicine, 1-1 Seiryomachi, Aoba-ku, HEV were found (Wantai, Beijing, curs during its manufacture. Usually Sendai 980-8574, Japan; email: kakuta-r@med. China), which led to the diagnosis of deep cooking is recommended on the tohoku.ac.jp acute hepatitis E. The HEV genotype package, but consumers might not fol- was 3f, as determined from the phy- low the cooking recommendation; also, logenetic analysis of a portion of the figatelli can be sold in small local shops open reading frame (ORF) 2 (2). The with no label. In the instance reported index case-patient recovered by the here, the figatellu was sold without any end of January; HEV viremia was un- warning label and was eaten raw. detectable on January 17, 2014. That HEV was transmitted The index case-patient and her through ingestion of contaminated Foodborne family regularly ate figatelli (raw pork food is supported by the following Transmission of liver sausages) made in Corsica. The evidence. First, 3 case reports have Hepatitis E Virus patient had most recently eaten figatelli provided direct evidence of HEV at a lunch with 8 family members on transmission through ingestion of from Raw Pork October 28, 2013, seven weeks before contaminated animal food products Liver Sausage, illness onset. After receiving informed with identical or near identical se- France consent, we conducted laboratory in- quences between the patients and the vestigations of samples from the other contaminated food they ate. Two cases To the Editor: The number of family members; tests included HEV occurred in the early 2000s in Japan sporadic autochthonous cases of acute serology and HEV RNA detection in through consumption of grilled wild hepatitis E is increasing in many in- serum and fecal samples. Samples were boar (4) or sashimi of Sika deer (5); dustrialized countries (1). These cases obtained from family members during the third, reported recently in Spain, involve hepatitis E virus (HEV) geno- January 8–21, 2014 (41–54 days after was transmitted through ingestion of types 3 and 4, which are zoonotic. the lunch). Positive HEV IgM and de- pig meat (6). Second, HEV widely in- Although risk for foodborne transmis- tectable HEV RNA were found in the fects domestic pigs and wild boar (7). sion from pork is now recognized, we serum of the index case-patient’s daugh- Third, swine and human HEV strains report here direct HEV transmission ter, who was asymptomatic. Because have genetic similarities and, in Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 11, November 2014 1945 LETTERS Figure. Phylogenetic analysis of partial open reading frame (ORF) 2 and ORF1 sequences of hepatitis E virus (HEV). Phylogenetic trees were constructed in MEGA6 software (http://www.megasoftware.net) by using the neighbor-joining method from a Kimura 2-parameter distance matrix based on partial nucleotide sequences of ORF2 (A) and ORF1 (B). Bootstrap values obtained from 500 resamplings are shown. Sequences were retrieved from the serum of a 45-year-old woman in France in whom hepatitis E was diagnosed in December 2013 and from frozen leftovers of the figatellu she had eaten in October 2013. Sequences obtained from the figatellu (GenBank accession nos. KJ603858 and KJ603860) were 100% nt identical to sequences obtained from the index case-patient (GenBank accession nos. KJ603859 and KJ603861). Reference sequences are indicated by their GenBank accession numbers. Scale bars indicate nucleotide substitutions per site. some cases, are indistinguishable (1). about the risk for HEV transmission Christophe Renou, Fourth, in Marseille, France, a case– through the ingestion of such delica- Anne-Marie Roque-Afonso, control study identified ingestion of fi- tessen was published by French au- and Nicole Pavio gatellu as a risk factor for HEV infec- thorities in 2010 (10), but the present Author affiliations: Hôpital d’Hyères, Hyères, tion. Genetic similarities were found case demonstrates that public educa- France (C. Renou); Hôpital Paul Brousse, between sequences isolated from pa- tion and warning, or larger and more Virologie, Villejuif, France (A.-M. Roque tients with autochthonous hepatitis E explicit labels on the package, must Afonso); French Agency for Food, Environ- and nonrelated figatelli purchased in be improved to reduce the risk for mental and Occupational Health and Safety, the same region (8). Finally, infectious HEV exposure. Maisons-Alfort, France (N. Pavio) virus, replicating in a 3-dimensional DOI: http://dx.doi.org/10.3201/eid2011.140791 culture system, was identified in a Acknowledgments HEV RNA-positive figatellu 9( ). We thank Elodie Barnaud and Stéph- References In the present study, the homol- anie Proust for their technical assistance. ogy between sequences recovered 1. Dalton HR, Bendall R, Ijaz S, Banks M. from the index case-patient and those This work was supported by the Hepatitis E: an emerging infection in recovered from leftovers of figatellu European Union’s Seventh Framework developed countries. Lancet Infect Dis. 2008;8:698–709. http://dx.doi.org/10.10 provides additional proof of HEV Programme (278433-PREDEMICS) for 16/S1473-3099(08)70255-X foodborne transmission in a West- research, technological development and 2. Haïm-Boukobza S, Ferey MP, Vétillard AL, ern country. In France, information demonstration. Jeblaoui A, Pélissier E, Pelletier G, 1946 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 11, November 2014 LETTERS et al. Transfusion-transmitted hepatitis Burkholderia Isolates from 3 persons who died (a sin- E in a misleading context of autoimmu- gle bacterial colony saved from each nity and drug-induced toxicity. J Hepatol. pseudomallei in 2012;57:1374–8. http://dx.doi.org/10.1016/ person) from Koh Phangan were also j.jhep.2012.08.001 Water Supplies, available for genotyping and analysis. 3. Barnaud E, Rogee S, Garry P, Rose N, Southern Thailand 26 (14%) of 190 samples were culture Pavio N. Thermal inactivation of infec- positive for B. pseudomallei. The pos- tious hepatitis E virus in experimen- tally contaminated food. Appl Environ To the Editor: Melioidosis is an itivity rate did not differ by source of Microbiol. 2012;78:5153–9. http://dx.doi. infectious disease caused by the en- the water sample: spring (5 [28%] of org/10.1128/AEM.00436-12 vironmental gram-negative bacillus 18 samples), well (17 [13%] of 127), 4. Li TC, Chijiwa K, Sera N, Ishibashi T, Burkholderia pseudomallei, which and tap water (4 [9%] of 45; p = 0.16, Etoh Y, Shinohara Y, et al. Hepatitis E virus transmission from wild boar meat. is present in northern Australia and Fisher exact test). Of the 26 samples, Emerg Infect Dis. 2005;11:1958–60. across much of Asia (1,2).
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